Healthcare Provider Details

I. General information

NPI: 1093855587
Provider Name (Legal Business Name): NW FLORIDA LUNG ASSOCIATES, PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/07/2007
Last Update Date: 03/30/2021
Certification Date: 03/30/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

322 RACETRACK RD NE
FORT WALTON BEACH FL
32547-2546
US

IV. Provider business mailing address

322 RACETRACK RD NE
FORT WALTON BEACH FL
32547-2546
US

V. Phone/Fax

Practice location:
  • Phone: 850-863-3000
  • Fax: 850-374-3200
Mailing address:
  • Phone: 850-863-3000
  • Fax: 850-374-3200

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License NumberME0058957
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. MICHAEL J. GIVEN
Title or Position: DOCTOR
Credential: MD
Phone: 850-863-3000